Pancreatic Cancer Flashcards
Prognostic Factors
Stage
- The most important (describes the amount of cancer in the body)
- More favourable is the cancer is found early and is resectable (stage 1 or 2)
Performance Status
- Measure of how well a person can do ordinary tasks and carry out daily activities
- People with a high performance status before surgery have a better prognosis than those with a lower performance status
Treatments (Stage I and II)
Resectable (Stage I and II)
- Surgery to remove part of all of tumour
- Adjuvant chemotherapy (after surgery)
- Radiation
- Chemoradiation if cancer is found in the tissue and in the tumour
Borderline Resectable
- Treated with chemotherapy and chemoradiation before surgery (neoadjuvant - shrink tumour)
- Clinical trials
Treatments (Stage III and IV)
Locally advanced (non-resectable Stage III)
- Chemoradiation, chemotherapy, and palliative surgery
Metastic (Stage IV)
- Chemotherapy
- Targeted therapy
- - Uses drugs to target specific molecules (for example, proteins) in cancer cells to stop them from growing and spreading. Targeting cancer cells means that these drugs don’t damage as many normal cells
- Palliative therapy (surgery, radiation, or both)
Surgical Options: The Whipple Procedure
The Whipple Procedure
- AKA pancreaticoduodenectomy
- Remove tumours in the head of the pancreas or in the opening of the pancreatic duct
- Removes the head of the pancreas along with the duodenum
- The gallbladder
- Part of the common bile duct
- The pylorus (bottom part of the stomach that attaches to the duodenum)
- Lymph nodes near the head of the pancreas
Surgical Options: The modified Whipple Procedure
- AKA pylorus- preserving pancreaticoduodenectomy
- Used to remove tumours in the head of the pancreas that are not large or bulky
- Haven’t grown into the duodenum
- Or spread to the lymph nodes around the pylorus
- Doesn’t affect normal stomach function
- Avoids nutritional problems that can happen after the Whipple procedure
Surgical Options: Distal pancreatectomy
- Used to remove tumours in the body or tail of the pancreas
- Removes the tail of the pancreas, or the tail and part of the body of the pancreas, and nearby lymph nodes. The spleen is only removed in the tumour has grown into the spleen or blood vessels supplying the spleen
- Distal pancreatectomy is not commonly used because cancer that starts in the body or tail of the pancreas has often spread by the time it is diagnosed
Surgical Options: Total pancreatectomy
- Used only if necessary to completely remove the tumour
- Very difficult to recover from this surgery, so it is not used as often as the Whipple procedure or the modified Whipple procedure
- Removes all of the pancreas along with the duodenum, and pylorus, part of the common bile duct, the gallbladder, sometimes the spleen and nearby lymph nodes
Surgical Options: Palliative Surgery
Palliative Surgery is used to relieve symptoms of advanced cancer
Can include stent placement and surgical bypass
- Can help relieve a blockage in the common bile duct or duodenum
Treatments: Chemotherpay
Chemotherapy is used to destroy cancer cells
- Some given on their own but most often several are given together
- Chemotherapy drugs have the greatest effect on rapidly dividing cells, such as blood cells in the bone marrow, cells lining the mouth and GI tract and hair follicle cells
- Assess for complications and treat PRN
Radiation used high energy rays or particles to damage or destroy cancer cells
Treatments: Chemoradiation/ Targeted Therapy
Chemoradiation
- Chemo and radiation given together
- Some types of chemo make radiation more effective
Targeted Therapy
- Target specific molecules (usually protein) involved in cancer cell growth while limiting harm to normal cells
Chemotherapy Side Effects
Bone marrow suppression Sore mouth Inflamed mucous membranes N/V Loss of appetite Changes in taste and smell Diarrhea Dehydration Constipation Fatigue Flu-like symptoms Hair loss Skin changes Eye changes Pain Cystitis Bed wetting Weight gain Pain at the injection site Inflamed vein Allergic reaction Fluid retention Organ damage Second cancers
Radiation Side Effects
Fatigue Skin Reactions Changes in apetite Radiation sickness Bone marrow suppression Reduced bone growth Anxiety or depression Sleep problems Changes in sexuality Second cancers Effects organs around the area of radiation
Nursing Care
Management of side effects
Pain management - IV, s/c, or oral (monitor IV site)
Mouth care PRN
Diet modifications for comfort and to improve appetite
Increase fluids and empty bladder frequently (cystitis)
- Diuretics PRN
Minimize the use of salts and fluids if edema present
Cool compress or warm bath to decrease vaginal itching
Administer anti-emetics
Minimize “strong smells”
Monitor for and treat dehydration
Monitor for and treat constipation or diarrhea
Encourage frequent rest periods
Nursing Care
Teaching re: hair loss in 2-3 weeks
- Cutting hair short, bandanas, wigs, hats
- Do not straighten, dye, or perm
Assess skin condition (redness to radiation location)
Encourage the use of sunscreen (chemotherapy)
Glasses rather than contacts
Assess anxiety level and depression (treatments and sexuality)
- Refer PRN
- Provide emotional support
- Assess support systems
Monitor sleeping patterns
Assess for secondary cancers
- Caused by chemotherapy and radiation
- Benefits outweigh the risks
- Higher incidence if treated with both
Follow-Up Care
Should maintain a regular schedule for follow-up in the first 2 years following surgery and/or treatments
Monitor side effects of treatments
